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Midwife

If you meet pre labour I cannot over emphasise the benefits of using a doula service – doulas connect with women and support them through pregnancy , labour, birth and the postnatal period – I value all doulas and I have learnt so much from them .

Sit beside the woman at her level , listen carefully with your eyes and your ears . Demonstrate that you accept her fear as real and tangible and do not dismiss it by saying “you’ll be fine, lots of women give birth”. When as a midwife you first meet a woman, it’s crucial for you to have open body language which means arms by your side , warmth in your eyes, and you should display love and truth . Ask the woman if she wants you to hold her hand , this is a connective proces and a simple yet effective of cementing your relationship with her .

Help the woman to gain a rapport with you and confidence in herself by demystifying some of her previous experiences eg the gas and air didn’t help last time , I tore badly last time , I failed at breastfeeding last time. this time it just might . Be a source of knowledge and light for her . Explain that you are with her that you love your job and you will be her advocate throughout .

Explain the process of pain in the cervix and why relaxation can help , use mindfulness links for her to listen to and actively take part in them with the woman and her partner to show your commitment to them both . Teach her that an internal examination is about choice, consent and that she is the one in control with an ability to stop the process at any time . Also explain her human rights matte in labour. . The woman may decide against internal examinations – be with her in this decision.

Hold the woman’s hand when she is talking to you , this will let her see that you are kind and that you want to help her . Say things like ” I can see vulnerability in your eyes , tell me how I can help you , I am with you” “how are you feeling at this present moment? ”

Ask what her fears are – one woman I met recently was so scared , she thought that she might die in labour – this may seem irrational but it’s acutely important to know that these expressions of fear are very real to the woman herself .

Don’t talk about feeding intention , sometimes a woman’s confidence and belief in herself are knocked for six when there have been difficulties with breastfeeding and this can manifest as fear in labour . Discuss instead why her newborn craves for skin to skin with her at birth and that these physiologically magical hours are also to help her feel validated once she has given birth .

Help the woman to focus on the moment not what might happen this is mindfulness in labour.

If a woman has had a straightforward birth before , her perception of it is what matters not what the notes say or the fact that it appears to have gone smoothly.

Try your best to stay in the room most of the time , even use the ensuite in the room yourself once you have asked her permission to do so . Your aim is to to reduce her anxiety and fear of being left by the midwife .

Handover information to the team on shift about the woman and her fear of birth so that staff enter the room peacefully and introduce themselves . If someone enters the room and doesn’t introduce themselves, do it for them.

Ensure that the partners voice is heard and that they see you are trying to help by using open questions . Learn what they do , how they met and see their love for one another .

Don’t push the woman to have stronger analgesia , the key is give information. It’s crucial to give full explanation of all analgesia and their effects not only on the woman but on the baby and its ability to feed after birth . The pain is the woman’s pain and she must feel heard regarding her analgesic choices.
Never underestimate the value of finding a midwife that knows the woman and also suggest aromatherapy. Frankincense is wonderful scent that reduces anxiety and if used in combination with other scents has a calming pain relieving quality .

Keep the room darker and ask staff to be respectful by not entering the sacred birth room – interruptions increase adrenalin response which blocks the production of oxytocin and if her partner can get on the bed too this helps the woman to feel safe and loved .

Explain that you will not talk loudly during the birth and also try not to leave the woman afterwards , complete all notes in the room . Sometimes the most vulnerable time for a new mother is immediately after her child is born . Staying with her to help with positioning and handling of her baby will serve to strengthen her own belief in herself .

Avoid using terms such as “good girl” use the woman’s name to speak to her so that a sense of trust is built upon .

Explain why prolonged skin to skin contact will help the woman after the birth , it is revalidating

If you think she might need your help with a shower or bath that’s fine – ancient cultures have washing rituals and cleansing is sometimes quite cathartic for a postnatal woman plus you are showing that you care about her and reaffirming that human kindness makes a difference to someone’s experience .

It’s important to be aware of fear of birth and how it manifests in women sometimes it’s difficult to recognise in the antenatal period and might not be disclosed until labour . Women with a fear of birth must’ve given time , feel listened to and feel supported .

Whichever way the birth takes place stay with the woman , and be a constant for her .

Lastly try to write a birth story for the woman from her newborn . When a woman sees words on paper that reflect how she gave birth and her newborns belief in her the effect is indescribable . This will pass into the next generation and you will be affirming birth to many others who read the letter. Never underestimate the effect that your actions , inactions or displays of love , kindness and compassion will have on a woman and her family , they will unknowingly to you. Quite simply your support kindness and compassion will last much longer than a lifetime.

Thankyou for reading and thank you to wonderful Claire Harrison midwife and friend for believing in me and inspiring me to write this piece .

Love from Jenny 💛❤️💛XXXX

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We’ve all been there – in a busy clinical area and a person or family are advised there is a change in care due to clinical findings, investigations, laboratory results . Time is limited but each person being counselled varies in their knowledge, understanding, intelligence and how they process the facts that are imparted to them. It can’t be a one size fits all but how exactly do health professionals communicate quality evidence to the people they care for and maintain an individualised approach?

Several NHS trusts are going paperless with leaflets available on line. This is a way forward but we must ensure there is access to computer or a phone with wi-if access . Some health care users may not want to admit they are technophobic, don’t have a computer or laptop or perhaps cannot read and/or write. I promote the use of libraries and also show how to access the hospital free wi-fi . It’s important to flag the hospital wi-fi which should be available for all staff ,visitors and patients – Trusts that don’t provide this are failing their patients and staff . Access to wi-fi has been jokingly added to the Maslow triangle

but on a serious note it’s standard in cafes, restaurants and hotels so please NHS follow suit – our business is hospitality after all .

Questions to ask about giving information

Is it relevant ?

Is it current ?

Does it link to evidence and research ?

Who decides how in depth it should be ?

Giving a leaflet is simply a starting point for a wider discussion it’s not a final statement . As health care professionals we should be constantly asking women and families “is there anything you need to know ? Any questions you have? ” as well as promoting a learning environment . We are helping women to become leaders for other women when we give valid , useful information out . There is no excuse for us to say “I wasn’t asked” anymore.

Health professionals must start the spark that gives the public a thirst for knowledge about their own health . I recently counselled a woman about carbon monoxide(CO) – she didn’t smoke but two of her close family members did . I offered them all Carbon Monoxide screening . The two family members CO levels were 1. Above 30 2. Above 25 . The non-smokers was 19 and wait for it I also measured my CO as a control – mine was 15 . I then realised I’d been in a closed room with the family for over an hour . The CO had affected all of us . This led to a discussion about the effects of smoking , the safety of nicotine but the dangerous effects of carbon monoxide and the way the tobacco industry makes an addictive product with hidden perils . The family chose smoking cessation as the results of the screening test surprised them (and me !) I didn’t nag them I befriended them and helped them to focus on how they could remove the product from their lives and not their guilt .

Below is a recent article by Jonathan Cliffe Midwife about personalising care for every woman – published in the British Journal ofMidwifery August 2016 .

The current financial status of the NHS is forcing many trusts to cut back on small things, but I believe that it’s the small things that make the NHS wonderful. The fact of the matter is we are here to provide a priceless service to families, parents and people. If we keep our focus on doing the best we can do each and every day by imparting the evidence which applies to the individual , looking at how the individual might help us to gain new knowledge, opening our minds to improving outcomes, valuing staff and patients alike then the only way that the NHS can possiblY move is in a toward direction.
I suggest you google “How to share evidence – NHS” you might find some valuable information to help your own NHS trust .

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There was once a factory in a far away land . The factory owner Fred took immense pride in his factory .

This was no normal place to work , the employees had to fold napkins at the same time as caring for an elderly person . This care involved mainly talking to the elderly person and making the person happy through conversation – this was an intrinsic part of their work – but I’d like you remember that the employee also had to fold napkins .

Suki was an employee at the factory , she was an amazing napkin folder and the top napkin folder at the factory . The factory owner raved on and on about how good Suki was at her job – he promoted her and used her as a role model of efficiency whenever he went to other napkin folding factories . Suki felt very proud and kept working hard .

One day Suki’s chair broke – so she had to move to another area whilst it was fixed . Suki sat next to Giles who was also a napkin folder – Giles wasn’t very productive but he did attain adequate levels of napkin folding to keep himself in employment . Suki noticed amazing things about Giles he was working but also chatting away to his allocated elderly person quite a lot , the elderly person was called Gertrude . Suki noticed that Gertrude looked very happy and Suki suddenly realised that all the years at the napkin folding factory her own allocated elderly person had never laughed like Gertrude .

The next day Suki went to see Fred the factory manager and told him about Giles & Gertrude . “I think we should watch Giles” Suki said . Fred the factory owner went to see Giles and immediately noticed how joyful he was in his work – Suki was happy but Giles had that extra ‘je ne sais quoi’ . The factory owner also checked all the records of all the elderly people that Giles had sat with whilst he folded napkins . A wonderful thing had come to light not only had no one complained but there were letters of thanks from families of the elderly people stating how kind Giles had been and recommendations for his promotion .

The next day Fred the factory owner made an announcement to all the people at the factory

“All of us within this factory should give a higher priority to making each elderly person happy over and above folding napkins. In this wonderful life we are simply spreading kindness , compassion and the human spirit . Look at Giles and Getrude and the happiness they emit and share . ”

Over the next few months the factory workers tried their best each day to give their priority to each of their allocated elderly people. A remarkable thing started to happen – productivity increased and surprise,y more napkins were folded than ever before but also the workers felt more valued and much happier about being at work – plus much more than that the physical and mental health of the elderly people involved took a significant improvement – because in the end we are on earth to be human .

I hope you enjoy my fable .
Thank you for reading
❤️Jenny❤️

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LeadToAdd click HERE to learn more is the latest NHS England campaign # is #LeadToAdd. As a Caremaker I will be linking this on Twitter with my work on #skinToskin , #futuremidwives and #couragebutter to inspire others to see themselves as leaders regardless of their role . Patients, women, families and non-clinical staff are also leaders .
I feel this will inspire/activate different meanings to different people

Here are some of my thoughts around it

What does to lead mean ?
To take charge , to be at the front , to inspire , to educate, to be diverse
Leading is about being at the front and CONSTANTLY looking back to bring others with you

Leading is about being the first to begin something but not necessarily holding onto that but looking at how your actions impact on the way others fulfil their role. Leading is being a positive role model, leading is about looking inwards at your own behaviour and also looking outwards at the behaviour of others .

In the NHS all staff need encouragement to recognise themselves as leaders and also to see that some behaviours do not embody leadership. We are all learning each day, so don’t stay still – question yourself and the way you speak to others . Ask a colleague to listen to you talking to patients and staff and to give you feedback -what could you change ? Integrate telephone conversations into drills training- talk to your practice development team – think outside the box .

Someone who leads others into poor practice is a poor leader but a leader non the less so be aware of your own commitment to pass the positive leadership baton . We are human and it’s ok to make mistakes , however we must learn, evolve and change .

The other day I had a car journey with Joan Pons Laplana (@ThebestJoan on twitter) and once again he made me think hard about how the 6Cs are integrated into practice . Joan said to me that as a health care professional all tasks and procedures must embody the 6Cs – even answering a telephone call.
As a form of reflection I’d like you to read passage one and then passage twoPassage One
Busy labour ward – phone ringing , midwife answered the phone – we will call the person making the call Tony and his partner who is having a baby is called Dolores. The midwives name will be Darcy .
Midwife ( confident and cheery) ” hello labour ward , midwife speaking how can I help you?”
Tony (nervous voice) ” oh hi – err my partner thinks she’s in labour , it’s our first baby and we are a bit nervous . Could I ask you some questions , she’s here but having a contraction right now and then she feels sick for a few minutes after its gone.
Midwife “oh right well I need to talk to her please and decide what’s happening’
I’m not going to continue this but could the midwife change her approach ? Is this midwife you ? A colleague? This approach has been learnt from a peerPassage Two

Busy labour ward – phone ringing , midwife answered the phone – we will call the person making the call Tony and his partner who is having a baby is called Dolores. The midwives name will be Darcy . ….

Midwife ( confident and cheery) ” hello labour ward , my name is Darcy Jones I’m a midwife and how can I help you?”
Tony (nervous voice) ” oh hi Darcy – I’m Tony – err my partner Dolores thinks she’s in labour , it’s our first baby and we are a bit nervous . Could I ask you some questions , she’s here but having a contraction right now and then she feels sick for a few minutes after its gone.
Midwife “ok well I would like to take some details first whilst Dolores has a contraction . Thank you so much for ringing us . How are you feeling ? This is your first baby ? How exciting for you both!”
I’m not going to continue this but could the midwife change her approach In either scenario – which is the best one in your opinion ? ? Is either of these scenarios you ? A colleague? This approach has been learnt from a peer.
So you see two examples each one leaving the person contacting the service with different emotions .
Start your journey as a #LeadToAdd leader today ❤️
Thank you for reading
Love , Jenny ❤️

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There’s a debate on Twitter this morning about the ‘natural caesarean’ as a term that promotes a positive experience of birth by caesarean. I don’t agree with the term and I think as health care professionals working in the area of birth we should ensure that every birth is a positive birth . Milli Hill started the The Positive Birth Movement with this goal in mind (@birthpositive on Twitter )

Bearing this in mind I’d like to ask the following questions for you to consider and share with with your colleagues, family , friends , midwives and obstetricians .
1. How many women who have an emergency caeserean and/or instrumental birth (forceps or ventouse) are given information in the antenatal period about the far reaching health and psychological benefits of skin to skin contact in this setting to both mother and baby ?

2. Compare the above with how many women are given information about skin to skin contact around normal birth ?

3. Compare both to how many woman are informed that skin to skin is possible during manual removal of placenta and repair of any perineal trauma in the theatre setting ?

4. Are women informed

They can TELL midwives to defer the weighing of their newborn in order to enjoy the benefits of prolonged skin to skin contact

That they should never be separated from their baby unless a clinical situation becomes apparent or they themselves choose not to have skin to skin contact despite being FULLY informed

That their baby could ‘self latch’ at the breast without any handling by staff and also correct its own acidosis and stabilise its own breathing because of skin to skin contact ?

That skin to skin and early breastfeeding “Pronurturance ” is linked to a reduction in the incidence of postpartum haemorrhage? CLICK RIGHT HERE for the Pronurturance paper

That if babies could talk they would choose skin to skin contact despite their birth environment

That skin to skin contact is the building block for a persons social and psychological development

The midwives and staff on social media who talk about caesarean are not promoters of it , they are giving women information about choice – so that if the operation (which is major surgery) does take place then these women are able to not only enjoy their birth experience but give their relationship with their baby the best possible start .

I suppose it’s similar to the question “does having a teenage pregnancy strategy increase teenage pregnancy rates ? (and I much prefer the term “young women”to ‘teenage pregnancy’)

Does having full information about your choices if you do go on to have a caeserean increase caesarean rates ? I don’t know the answer to either of these questions but I do know that the women I have assisted and sometimes fought for to have skin to skin contact with their newborns in different birth situations have all told me this

-that they never realised the positive impact it had on them as a successful mother

To me this is enough .
Thank you for reading

With love , Jenny ❤️

I am also promoting #MatExp as a platform which enables and encourages discussion between women, families and health care professionals .

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Last year I was lucky enough to work in a general theatre for a week . I met a wonderful general surgeon and watched him perform bowel surgery . I noticed immediately how gentle and kind he was with the internal tissues and how calm and respectful he was not only towards the patient and his body , but also the staff in the operating theatre. All the staff admired this surgeon – you know when you can just tell ?

I asked the surgeon afterwards about his technique and he said this

“I always respect the tissue Jenny- tissues , blood vessels , muscle and skin are part of our human make up and being gentle with them means I am showing tissue respect and respect to the patient who is a fellow human . Being a gentle surgeon takes longer but believe me the outcomes are better and I know that there is less trauma , post-op bleeding , infection, pain and therefore happier patients and staff .”

Currently there is a lot in the news and emerging research around “The Gentle caesarean” and I am looking at this from a different angle (and for those who know me well I don’t do acceptance well – I like to ask things so that others unable to ask might think differently ) so I am questioning what this term “Gentle Caesarean” actually means . Does Gentle Caesarean mean just the moment of birth or should it be right from the decision or choice of the woman to have an operative birth through to arriving home ?

So for all those who work in the field of midwifery , obstetrics , intra-operative care, surgery , pain management -I would like you to watch a caesarean from start to finish and ask yourself “was that a gentle caesarean from that the moment that the woman arrived in theatre ? Was there gentleness with the woman’s feelings and choices ? Did the obstetrician, scrub midwife and others maintain gentleness towards the internal tissues and the to the baby? Was the transfer to the bed from the operating theatre table gentle ? Was privacy and dignity maintained at all times?

Just because we have always done something a certain way does not mean that “the way” is always the best .

I hope I spark someone to change practice and make “The gentle caesarean” standard across the NHS because then it will spread globally – we must question on a daily basis what we do and why we do it .
Thank you for reading , please leave feedback and / or share this blog with your colleagues
With love and midwifery kindness ,

❤️Jenny❤️
Addendum today I am thrilled that The Times journalist Katie Gibbons has written an article about skin to skin contact at Caesarean CLICK HERE to access or being the rebel that I am here’s a photo 😁